Fuhrman grading system

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A nuclear grading system for renal cell carcinoma based on nuclear size, nuclear contours and the presence/size of nucleoli.[1] Grade 1 is the most favourable, grade 4 the least.

The original case series was a composite of a different renal cell carcinoma variants. Its utility for the clear cell variant is more compelling, but not completely so, particularly when other factors like stage are taken into account (in studies where multivariate analysis has been performed). It is less reliable for the papillary variant, for which other grading system have been mooted.[2][3]

One problem is that grading assesses nuclear size, nuclear pleomorphism and nucleolar prominence. Where there is discordance between any of these three factors, it is not clear which component should be given priority.

Fuhrman Grading (take worst area, even if focal)
Grade Nuclear size Nuclear quality Nucleoli
Grade 1 10 μm small, round and uniform absent to inconspicuous
Grade 2 15 μm larger, crinkly nuclear membrane inconspicuous (visible at x40)
Grade 3 20 μm irregular nuclear membranes conspicuous (visible at x10)
Grade 4 >20 μm irregular nuclear membrane, pleomorphic, multi-lobed with clumped chromatin; +/- sarcomatoid spindle cells very prominent

References

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